4. Drug-Drug Interactions

Patient profiles will be assessed to identify those drug regimens, which may result in clinically significant drug-drug interactions. The following drug-drug interactions are considered clinically relevant for immune globulins. Only those drug-drug interactions classified as clinical significance level 1 or those considered life-threatening which have not yet been classified will be reviewed.

Live/Live Attenuated Virus Vaccines1,2

(e.g., measles, mumps, rubella, varicella) [clinical significance level- major (DrugReax); 2-major (CP)]

Adjunctive administration of immune globulins with live/live attenuated virus vaccines may inhibit the immune response to the vaccination by passively transferring antibodies and diminishing the desired vaccine effect. Antibodies present in immune globulins may diminish the response to mumps, rubella, and varicella vaccines for up to 6 months, while the measles vaccine response may be compromised for up to one year or more. Do not administer live vaccines for at least three months after immune globulin administration. Immune globulin and the hyperimmune globulin, varicella zoster immune globulin, should not be administered concurrently with the live varicella zoster vaccine. There should be at least a five-month interval between immune globulin (including varicella zoster immune globulin) administration and live varicella vaccination. Immune globulin should not be administered for two months after live varicella vaccine administration unless the benefits of immune globulin administration outweigh the potential for reduced vaccine effects.